I am one of roughly 1 in 5 American adults who struggles with depression, or what David Foster Wallace characterized as “The Bad Thing” before succumbing to the illness himself. Secretary of Health and Human Services Robert F. Kennedy Jr. wants people to stop taking the medications that have helped me to not only survive, but thrive.
While I have also struggled over the years with chronic medical issues, depression has without a doubt been the most disruptive to my career and broader fulfillment. I was actually not the first person to realize that I was depressed. My endocrinologist observed my mood and hypertension during my first year of graduate school, and he expressed concern and suggested I seek help. I had just been so accustomed to a metaphorical cloud hanging over me that I didn’t see an alternative until I tried therapy and about a year later, medication.
I wasn’t resistant to antidepressants per se, but I didn’t seek them out because I feared that they might make me feel numb or otherwise less like myself. I couldn’t have been more wrong.
Kennedy’s recommendations unnecessarily stigmatize SSRIs, and risk overcorrection.
They were not a crutch, or a replacement for doing the hard work of managing depression and anxiety and figuring out how to do things like compartmentalize and set boundaries. But after trial and error amid several medication combinations, I regained a sense of self and purpose. I could engage in that therapeutic work and my relationships. I could devote more time to my career writing and teaching on health policy.
This is why Kennedy’s initiatives to rein in the prescribing of selective serotonin reuptake inhibitors, or SSRIs, are so dangerous. All too often, the challenge facing Americans struggling with mental health isn’t overprescription but insurance barriers, along with stigma around treatment that has been addressed over the years but which the administration’s approach risks exacerbating.
In a statement released Monday by the Department of Health and Human Services, Kennedy announced “action to confront our nation’s mental health crisis by addressing the overuse of psychiatric medications.” Kennedy has taken aim at “overprescribing” and “overmedicalization” of mental health, in effort to shift toward what Kennedy calls a “holistic approach to mental health.”
Roughly 17% of Americans take some form of antidepressant. The most common are SSRIs (e.g., Zoloft, Prozac and Lexapro), which tend to be a first-line medication treatment due to their effectiveness, safety and typically mild side effects.
To be sure, these medications are not appropriate for everyone. For many people, therapeutic approaches such as cognitive behavioral therapy have proven highly effective, whether in lieu of or in addition to medication. That is why there are already prescribing guardrails in place: Trained providers evaluate their patient and the clinical appropriateness of a given medication, and in the case of brand drugs or otherwise costly medications, prior authorization (or required preapproval by a health insurer) is often applied.
In fact, a review of overprescription across drug classes only identified overprescription of antidepressants in subsyndromal cases — that is, when the patient did not meet the diagnostic criteria. It is a worthy goal to ensure that prescribing is focused on those who are likely to derive the greatest benefit, but Kennedy’s recommendations unnecessarily stigmatize SSRIs, and risk overcorrection and the underprescription of medically necessary care. While there has been growing openness in discussing mental health, 35% of Americans said in a Harris/APA poll that they would view someone differently if they learned that the individual had a mental health condition. Seeing the highest-ranking official in the Department of Health and Human Services characterize effective antidepressants as something to be avoided and “harder to quit than heroin” is bound to increase that number.
What’s more, in writing my new book, I found that psychiatric care is one of the more common types of care that health insurers delay or deny. Patients are then ensnared in the red tape of modern medicine, left to navigate cumbersome appeal processes even as their conditions may exacerbate feelings of hopelessness and defeat.
The Make America Healthy Again agenda likes band-aid solutions.
Tellingly, top HHS officials penned a “Dear Colleague” letter to accompany Kennedy’s announcement, in which they advise clinicians to “support a treatment approach grounded in shared decision-making, patient autonomy, and fully informed consent.” This is perfectly reasonable advice, but it is already part of clinical decision-making. For example, Drug A may affect sleep or energy level. Drug B may cause modest weight gain, but in combination with Drug C may provide optimal relief. The patient and clinician discuss options and reach a decision. Consideration of medication trade-offs is essential to any prescribing, and when it isn’t taking place, this can be addressed without stigmatizing prescription drugs and those who take them.
Similarly, the letter admits that “psychiatric medications can play an important and, at times, essential role in treatment” but says “medication should not be understood as the only treatment option.” That view is already standard in clinical decision-making.
Not everyone who goes on an antidepressant needs it for a long duration, so deprescribing may be an appropriate conversation between the patient and their clinician. But that should be shaped by clinical factors and evidence rather than matters of policy concerning how the nation thinks about mental health and the nebulous concepts of “holistic” and “wellness.” As for the letter’s alternative treatment options, such as psychotherapy, improved nutrition and physical activity, these can be excellent additions to a plan to address depressive symptoms. But they are not a replacement for safe and effective medications that can correct potentially debilitating neurochemical imbalances.
It is difficult to take seriously the administration’s concern about Americans’ mental health at a time when it has made or advocated for large-scale cuts to Substance Abuse and Mental Health Services Administration, Medicaid (which covers a disproportionate share of those with mental illness and substance use disorder) and the Affordable Care Act (when quality insurance coverage is an essential, though often insufficient, condition for mental health treatment). Advocacy for improved nutrition likewise rings hollow as Republicans slash support for the Supplemental Nutrition Assistance Program.
The Make America Healthy Again agenda likes band-aid solutions: eating healthily, exercising and focusing on overall “wellness.” These ideas are all well and good, but they don’t address systemic barriers to health and treatment. For example, as of 2024, 122 million Americans lived in areas with a shortage of mental health providers. This helps explain why nearly three-quarters of antidepressant prescriptions are issued not by psychiatrists, but by primary care providers. This provider shortage is untenable, but Kennedy would rather blame pharmaceuticals instead.
Branding antidepressants as classes of drugs to be avoided will reduce the likelihood that others will pursue the evidence-based treatments from which I have benefited, and which have allowed me to build a career researching health insurance barriers and inequities. The denigration of antidepressants offers cold comfort to those struggling with depression and yearning for relief. These drugs are not a silver bullet, but they have been part of my broader health journey and that of millions of others. Policies and rhetoric that cast doubt on evidence-based care risk taking away the tools that have made progress like mine possible.
Miranda Yaver
Miranda Yaver is an assistant professor of health policy and management at the University of Pittsburgh and a health care fellow at the Roosevelt Institute.